Outcomes of Tibiotalocalcaneal Arthrodesis in Charcot Neuroarthropathy According to Severity of Preoperative Deformity

Category: Diabetes; Hindfoot Introduction/Purpose: Patients who have severe hindfoot Charcot neuroarthropathy and require surgical intervention often present with several medical comorbidities. When they undergo reconstructive surgery (tibiotalocalcaneal arthrodesis), they may inadvertently suffer from various complications, including infections, nonunion, delayed ambulation, and subsequent limb amputation. Therefore, appropriate treatment plans should be established to avoid potential complications, and prognosis should be predicted before surgery. This study aims to explore the influence of the preoperative deformity degree in hindfoot Charcot neuroarthropathy on the outcomes of tibiotalocalcaneal arthrodesis. Methods: Twenty patients who underwent tibiotalocalcaneal arthrodesis because of hindfoot Charcot neuroarthropathy were evaluated retrospectively. They were classified into the severe deformity group if the tibiotalar angle was < 80 degrees or >100 degrees or if they had severe osteolysis of the talar body. Those without such conditions were categorized into the mild deformity group. Their demographics, comorbidity, and various surgical outcomes, including the presence of bony union, ambulation status, and performance of major amputation, were compared between the two groups. Results: With the numbers available, demographics and comorbidity did not significantly differ between the two groups. Postoperative outcomes, including postoperative infections, malalignment, bony union rates, time to union, and the rate of poor clinical outcomes, did not significantly vary between the two groups with the numbers available. The patients with a history of preoperative wound and postoperative infection showed worse clinical outcomes although tibiotalocalcaneal arthrodesis was performed after the preoperative wound was relieved. Conclusion: The severity of preoperative deformity and the osteolysis of the talar body were not associated with the outcomes of tibiotalocalcaneal arthrodesis on hindfoot Charcot neuroarthropathy. The presence of preoperative wound might be related to poor outcomes, and more caution is needed in treating these patients.